Mental illness and suicide: a physician’s story [PODCAST]

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“Sufferers of mental illness often believe that others feel they have control of their symptoms, only having to decide to not be, for example, depressed. While they themselves suffer the symptoms of mental illness, they often have the feeling that they should be able to control them. Depending upon their experience, the observer of the mental illness sufferer believes that the patient can decide to some extent to not feel the symptoms.

Others feel that the mental illness sufferer is somehow to blame for their suffering.

When observing someone with mental illness, the examiner does not see signs referable to the condition. Information concerning the patient’s clinical condition consists entirely of symptoms and must be related to the clinician. There are no true signs of mental illness, but rather feelings; conditions that are inside, and hence invisible to everyone else. This invisibility leads to feelings of isolation and the destructive feeling that their suffering is by the fault of themselves.”

William Lynes is a urologist.

He shares his story and discusses his KevinMD article, “The invisibility of mental illness.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show we have Bill Lynes. He is a urologist, and he wrote the KevinMD article “The invisibility of mental illness.” Bill, welcome to the show.

William Lynes: Thank you for having me, Kevin. I really appreciate it.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

William Lynes: Sure. I’m a physician, as you mentioned. I’m a urologist, as you mentioned. But what most people don’t know about me is that I’m a survivor of multiple suicide attempts.

I guess I’ll start off talking about when I went to medical school. I went to medical school in Galveston, Texas, at UTMB, and got my medical degree; that was 1981. Then I did a urology internship and residency at Stanford University; that was 1981 until 1987. In 1987, I moved to Southern California with my wife and my family, and I started practicing urology at the Southern California Kaiser Permanente Medical Group in Riverside, California, which is in Southern California.

What I would like to talk about is the period of time that I practiced medicine. I can divide that period of time, which would be 1987 until 2003, into two distinct eras. The first era was one where I had a really happy, busy, successful urologic practice and private life. But in 1998, something happened to me, which I’ll mention in a moment, and I began what I call a downward spiral into darkness, which is sort of code for suicidal behavior. Call it also my demise.

What happened to me in 1998 was that I went on a vacation outside of the country. When I came back, I didn’t feel well, and eventually I woke up one night with shaking chills and fever. I ended up being intubated in the Kaiser intensive care unit within around two hours, literally, for septic shock and respiratory failure. I was in the intensive care unit for six weeks. I had a tracheostomy. I lost 40 pounds. I had all the manifestations of sepsis, with DIC and ARDS and so forth. Somehow I survived, I rehabbed, and I went back to work.

But what happened to me is that about a year and a half later, I had a snowboarding accident, again on a vacation, and I sustained multiple facial fractures, and I had to have five facial operations. I was in the ICU again. I lost 40 pounds again. I had a tracheostomy again. Somehow I survived this and was able to go back to work two months later.

But when I went back to work, Kevin, things were just not the same for me mentally. I suffered, just to put it in easy terms, from depression, severe depression. It was a black depression, worse than I’d ever had before. It was day after day, it was grim, and there seemed to be nothing I could do to help myself. I started seeing psychiatry at that time, and they feel that I have bipolar II affective mood disorder. I was introduced to the wonderful world of antidepressants and mood stabilizer therapies, and I also had electroshock therapy. I have had over 30 treatments with electroshock therapy.

But when I would go back to work, I just was not the same. The excitement was gone. I had trouble getting to work. I had trouble in the operating room, at least I perceived that I did. And I decided to try to kill myself. I tried suicide on three occasions, the last being 2003, when I retired from medicine. I decided at that time that in order to save my life, I would have to leave the practice of medicine.

Then, if you fast-forward into 2017, I wrote an article that was published in the Annals of Internal Medicine called “The Last Day.” It was a treatise, say, an essay, which chronicled my last day of medical practice and that suicide. I had tremendous improvement with that, and with continuing to be an advocate and a speaker, a tremendous improvement in my mental outlook and in the way I felt about myself. So I’ve been an advocate on physician burnout and suicide since that time, doing various speaking and writing jobs. That’s sort of my story. That’s basically my story.

Kevin Pho: And you go more into that in your KevinMD article. It’s titled “The invisibility of mental illness.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to share it?

William Lynes: Yes. I wrote that article in 2007, actually. I just sort of percolated it around. The premise of the article is that for the treatment, the follow-up, and from the patient’s standpoint as well, there are no hard signs associated with mental illnesses. There are symptoms, which are things that patients tell you, but there are no signs, which are things that you measure. If you have an upper respiratory tract infection and you have a fever, it sort of confirms that you’re sick. But in the case of mental illness, there really isn’t anything like that. People have a hard time appreciating what depression is, and to what degree you have it. So I just put that into the idea that it’s sort of invisible. It’s invisible to the observer, and it’s really invisible to the patient.

It introduces some difficulties. From the observer physician’s standpoint, they don’t have corroborating pieces of information: “I feel that you have bipolar disease. I’m going to get a lab test.” That doesn’t happen. It’s a subjective type of measurement that goes on. So there’s some difficulty with that.

But especially from the patient’s standpoint, I always got the feeling that people thought I was faking: “You can’t really be that depressed.” And if I had been able to turn to, “Well, yeah, my GHR level is 65, and that proves that,” that would have taken some of the burden off of me. But unfortunately, we don’t have that. So that’s sort of the premise of the article.

Kevin Pho: Now, when you said that some people thought that you were faking your symptoms, are we talking about people at your workplace?

William Lynes: Well, yeah. I mean, nobody ever said, “I think you’re faking,” but I often felt a tremendous amount of guilt about being ill, mentally ill. There were certain people who accepted me, and then other people who did not. So yeah, primarily in my case, it was in terms of my work environments.

Kevin Pho: Now, when you were still practicing, how much did the medicine itself contribute to some of the behavioral health issues that you describe?

William Lynes: No question. Yeah, no question. I had a long, long career of what I call the culture of overwork. Trying to juggle my medical practice with my family life all led to sort of a classic burnout situation. If I had had a situation where I could have taken an administrative job, that might have helped, but I didn’t. So I just continued to practice urology, and I was really busy in my practice, as most physicians are. So yes, it definitely did contribute to my downfall.

Kevin Pho: And shortly before you stopped practicing, was there anyone who pulled you aside and said, “Bill, I think you should take a break. I think you should see someone”? Did any of your colleagues or people that you worked with notice any of the warning signs?

William Lynes: Well, in my case, my first suicide attempt was hidden from everybody. For my second suicide attempt, I took a massive overdose, and I ended up in a locked psychiatric ward, and it was sort of out of the bag at that point. I had to go in front of a hospital wellness committee, and there were certainly many, many people on that who said, “You really shouldn’t be practicing medicine.”

But I had a dear friend; his wife actually called me one night to talk to me about my depression. But beyond that, I didn’t. I blame myself. I really was very, very hidden in hiding my psychopathology. Once I had that massive overdose, everybody knew it, but not that many people came up to share and to help me.

Kevin Pho: Now, if you were to start your medical journey all over again, let’s say before you started practicing, what would you have done differently back then?

William Lynes: I would realize that I had this tremendous ability to overwork, and I would be on the lookout for that at all times. I would try to balance my life between my family and my work in the office much, much better.

One thing that really bothered me, and this would be in the early ’90s, is, you remember, laparoscopic surgery was coming in, especially to urology. The question is, when you’re not in a training program, how do you learn that? It really bothered me, because I needed to do it, and I did it, but I never felt like I was properly trained to do it. So if I had taken a sabbatical and learned some of the new advances in surgery, I probably would have done a lot better. And then the last thing is, I think that I should have pursued some nonclinical administrative job. So those are some of the things that I think about.

Kevin Pho: Now, when you say that you would have balanced your life a little bit better between medicine and family, what exactly would that have looked like? Would that be just fewer hours in the OR or the clinic? Would that be taking that administrative job? In your mind, what would that have looked like?

William Lynes: I believe probably all of that. I worked very hard. I came home very late. I did those sorts of things, and many, many physicians do that as well, so I’m not alone here. But it seems to me that I could have been more efficient, more mindful of the fact that I needed to be off when I was off. So yeah, that’s what I would say.

Kevin Pho: We’re talking to Bill Lynes. He’s a urologist, and he wrote the KevinMD article “The invisibility of mental illness.” Bill, thank you so much for sharing your story. And as you said, a lot of physicians are in similar positions now to where you were back then. Tell me what kind of warning signs they should be looking out for, and what kind of advice you have for these physicians who may be on the brink of burnout.

William Lynes: I think that there are two major things that the burnout, if you will, physician can do. One is to seek mental health treatment, psychiatry, therapy, that sort of thing. Don’t be afraid to do that. I think physicians just don’t want to talk to a psychiatrist. Studies have shown that that sort of treatment is beneficial in burnout and suicide risks.

The second thing that I found, which was just a tremendous relief, was to admit your problems, in my case to the world. It somehow just takes the burden off of feeling embarrassed about it. If you’re not embarrassed to admit that you have a problem, it just takes a tremendous amount of a burden off of you. So those are the two sort of take-home messages that I would like to leave with the audience.

Kevin Pho: Now, you’ve shared your story, of course, on KevinMD, and you’ve written articles in the Annals of Internal Medicine. I’m sure a lot of physicians have heard your story. In general, what are some of the responses that you receive after you share your story?

William Lynes: 99.9 percent very, very good. Most of them are, “You’re very brave. Thank you for doing that. I’m having trouble too.” Every time I speak, I get one or two people who contact me, and one guy said he was crying as he was typing an email to me. That’s the kind of response.

I did have one interesting response that I put in that negative category, which is, I believe in “The Last Day,” I write that I took a cowardly way out and tried to kill myself, or something like that. The person’s point was that suicide shouldn’t be thought of as a cowardly option. And I did not mean that all people who attempt suicide are cowards, by any means. I just meant that in my own case, as I look back, I feel somewhat cowardly. I had three children and a wife. So that’s the only negative I’ve got. The great, great majority have been very, very positive.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

William Lynes: Well, the main thing is that I found tremendous improvement in admitting my psychopathology, and it’s almost, really, it’s almost immediate relief. It makes you not afraid to have somebody know that you are having that sort of problem, if you already can confront it. And the second thing is that restructuring your life, for the physician, and then seeking mental health care is important in the treatment of the burnout, possibly suicidal physician.

Kevin Pho: Bill, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

William Lynes: Thank you.

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